Category Archives: Community Health
At this week’s Spotlight: Health conference, an expansion this year of the annual Aspen Ideas Festival, angel investor Esther Dyson will be talking about “The Way to Wellville,” a contest that her nonprofit Health Initiative Coordinating Council—or “HICCup”—is organizing to encourage a rethinking of how communities produce health. The Way to Wellville is a five-year national competition among five communities to see which can make the greatest improvements in five measures of health and economic vitality.
“In the end, we hope to show that the best way to produce health is to change multiple interacting factors—diet, physical activity, preventive measures, smoking and the like—as well as more effective traditional health care,” said Dyson. “We’re less concerned with specific ‘innovations’ or digital miracles and more with simply applying what we already know at critical density.”
The five health measures have not been finalized yet, but are likely to include health impact, financial impact, social/environmental impact (such as crime rate or high school graduation rate), sustainability (such as a health financing system) and a specific “wild card” that each community will set for itself, such as teenage pregnancy or smoking rates.
NewPublicHealth spoke with Dyson ahead of the Spotlight: Health conference about the Wellville contest.
NewPublicHealth: How did the contest come about?
Esther Dyson: I had signed up to be a judge on the Health Care X Prize, but unfortunately it never materialized. For the next few years I kept thinking somebody should do this, and as I got more and more interested in health, I thought that with greater and greater enthusiasm. I had to give some remarks at a quantified self conference last year and was going to say that “someone should do this.” But I realized that would be a very lame talk and ultimately I announced that I would do it. Having appointed myself, I arranged several open-call brainstorming sessions. At one of them, a nice gentleman showed up with lots of awkward questions about metrics, funding, evaluation...the usual! So I appointed him as CEO. That’s Rick Brush, who formerly worked at Cigna and more recently has been running asthma-prevention programs with innovative financial models.
Building a Culture of Health—one where health is a part of everything we do—will not be an easy task. In fact, it will be very hard, admitted Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation.
It’s a “call to action for all of us,” said Bill Frist, “but these six communities show it can be done.” The six communities in question are the 2014 winners of the RWJF Culture of Health Prize, announced yesterday at the Aspen Ideas Festival. Each community, while different in its own way, thinks about health in a whole new way, as being impacted by all aspects of daily life—from food production to urban design.
Why were these communities chosen from more than 250 applicants from across the country? They’re harnessing the power of partnerships; focusing on lasting solutions; working on the social and economic factors that impact health, such as education and poverty; creating equal opportunities for health for everyone in the community; making the most of resources; and measuring and sharing results.
But what really sets the Prize communities apart, said Lavizzo-Mourey—the “magic ingredient” and the “secret sauce”—are passion, purpose and even joy.
“What we mean by ‘building a Culture of Health’ is shifting the values—and the actions—of this country so that health becomes a part of everything we do,” said Risa Lavizzo-Mourey, MD, MBA, president and CEO of theRobert Wood Johnson Foundation (RWJF), during her keynote address at Spotlight: Health. RWJF is a founding underwriter of the two-and-a-half day expansion of the annual Aspen Ideas Festival.
“With health, each one of us can make the most of life’s opportunities,” she said. “That’s why we at the Robert Wood Johnson Foundation have made building a Culture of Health our North Star—the central aim of everything we do.”
Lavizzo-Mourey explained that the Foundation brought the Culture of Health concept to the Festival because of this year’s theme of “Imagining 2024.”
“When it comes to building a Culture of Health, I believe a decade from now we will have a powerful story of how we resolved to no longer accept that our nation spends more than $2.7 trillion dollars on health care, and yet continues to lose $227 billion dollars in productivity each year because of poor health,” she said.
Lavizzo-Mourey told the audience—which included health thought leaders from around the country—that building a true Culture of Health means changing our current understanding of health and creating a society where everyone has the opportunity to lead a healthy life. She gave the example of the Metro system in Washington, D.C., where babies born in the region of the Red Line—which intersects some of the wealthiest counties in the country—can expect to live to be 84 years old. However, babies born just a few stops away will have lives that are up to seven years shorter.
According to Lavizzo-Mourey, there are multiple ideas being practiced around the country that contribute to the emerging Culture of Health, including:
- Helping patients with things such as housing and food assistance at every medical visit.
- Changing the workplace culture to be a healthier one, including using stairs instead of elevators and holding standing or walking meetings.
She also enumerated several key ways that RWJF is working to build a sustainable Culture of Health, including committing $500 million toward reversing the U.S. childhood obesity epidemic; helping to ensure that everyone who is eligible for health care coverage knows about the benefits available to them; encouraging businesses to take the lead in investing in the wellbeing of the communities they serve; and addressing community violence.
Health Beyond Health Care: RWJF-Sponsored Washington Post Live Event Sparks Conversation on Creating a Culture of Health
“Health Beyond Health Care” was the focus of a Robert Wood Johnson Foundation (RWJF)-sponsored Washington Post Live Forum today that looked at how creative minds in traditionally non-health fields—such as bankers, architects, designers and educators—are working together to build a Culture of Health in the United States.
“No matter where you live and how much money you have, you should have the opportunity to live a Culture of Health,” said RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA.
>>View the full archived live stream of the forum.
Lavizzo-Mourey said RWJF began its work on the concept of a U.S. Culture of Health in 2009, when the foundation’s Commission to Build a Healthier America released a report recommending the concept. Last year, the Commission came together to see what progress had been made. Among the sites embracing the concept is Marvin Gaye Park in Washington, D.C. Once known as “Needle Park,” the community has transformed itself through lighting and landscaping. This was possible “because the community embraced the principles of a Culture of Health and demonstrated how, from the ground up, people partnering can change the nature of their community and make it healthier,” she said.
Pointing to the most recent Commission report, Lavizzo-Mourey said that looking at communities undergoing changes pushed the Commission to conclude that in order to improve health as a nation, we have to change communities—especially low-income communities—so that people can make healthy choices every day. That also means that health care has to connect with non-health care.
“Each of you,” she told the audience of thought leaders and policy makers, “is uniquely positioned to make changes that can get us to a nationwide Culture of Health.”
The day’s speakers spoke about innovations in their fields that are helping to create local changes in health, and which are often scalable for communities across the country.
“The most successful projects are those that start with bringing communities together to first assess the need, and then prioritize them and move forward with a particular project,” said Sister Susan Vickers, RSM, Vice President of Community Health, Dignity Health, who added that just about all the loans that Dignity Health has made to nonprofits in the community have been repaid.
Why a focus on health? “Health summarized all [of the other factors],” said David J. Erickson, PhD, Director, Center for Community Development Investments, Federal Reserve Bank of San Francisco. “The best predictor for future health for a third grader is whether they are reading on a grade level. Community development is big, but not big enough, and the medical system is not big enough either. We need to start aligning all of these sectors so we’re all working in the same direction to turn these neighborhoods around.” [Editor’s Note: Read a previous NewPublicHealth Q&A with Erickson.]
“We have to treat health as a national treasure—a natural resource—and put it up on the level of the seriousness of the economy,” said Rear Adm. Boris D. Lushniak, Acting U.S. Surgeon General. “The economy doesn’t do anything without a healthy people.”
Application Problems Mean 2.2M People Risk Losing ACA Coverage
Inconsistencies in their application data means that approximately 2.2 million people who enrolled for coverage under the Affordable Care Act could risk losing their coverage in isolated cases. A report from the U.S. Centers for Medicare and Medicaid Services (CMS) found that 1.2 million people filed health insurance enrollment applications with questionable income data, 461,000 had issues with citizenship and another 505,000 had issues with immigration. However, CMS also noted that 59 percent of the applications were within a 90-day window allowing them to resolve the problems. “Consumers experience regular changes in income and various life circumstances and the law accounts for these kinds of situations," said CMS, according to Reuters. "It is not surprising that there are income discrepancies given that this is a brand new process." As of mid-April more than 8 million people had enrolled for health coverage. Read more on the Affordable Care Act.
Study: Skipping Breakfast Doesn’t Hurt Efforts to Lose Weight
Common wisdom holds that people who skip breakfast actually increase their risk of obesity. However, a new study in the American Journal of Clinical Nutrition found that passing up on the first meal of the day neither helps nor hurts a person’s efforts to lose weight. The study involved 309 overweight and obese adults between the ages of 20 and 65—who were told to either eat or skip breakfast—and a control group provided with health nutrition information. Researchers found no difference when it came to efforts to lose weight. "The field of obesity and weight loss is full of commonly held beliefs that have not been subjected to rigorous testing; we have now found that one such belief does not seem to hold up when tested," senior investigator David Allison, director of the UAB Nutrition Obesity Research Center, said in a university news release. "This should be a wake-up call for all of us to always ask for evidence about the recommendations we hear so widely offered." Read more on obesity.
HHS: $300M Available to Expand Services at Community Health Centers
An additional $300 million in funding is available to community health centers as part of the Affordable Care Act, U.S. Health and Human Services Secretary Kathleen Sebelius announced this week. The funds will go toward expanding service hours and the hiring of more medical providers, as well as the expansion or addition of oral health, behavioral health, pharmacy and vision services. There are approximately 1,300 health centers operating more than 9,000 service delivery sites and providing care for more than 21 million U.S. patients. Read more on community health.
GlaxoSmithKline, Local Organizations to Give Nearly $1M in Grants to Nonprofits that Improve Community Health
In partnership with local community organizations, GlaxoSmithKline (GSK) is offering non-profit organizations 20 grants totaling $40,000 each in the Durham, N.C. and Philadelphia, Penn. regions through its GSK IMPACT Awards. The annual grants will be awarded to nonprofits in recognition of their exceptional achievements in contributing to a health in their regions. “Where we live matters to our health,” said Katie Loovis, Director, U.S. Community Partnerships and Stakeholder Engagement, GSK. “Through the GSK IMPACT Awards, we will find and honor some of the most outstanding local nonprofit organizations that are leading the difficult and often thankless work of making our community a healthier place to live.” Read more on community health.
Study: Climate Change Will Make it Harder to Keep Ozone Pollution in Check
Rising temperatures due to climate change will make it more difficult to monitor and keep in check ozone pollution in the continental United States, according to a new report from the National Center for Atmospheric Research (NCAR). The study, to be published in the Journal of Geophysical Research-Atmospheres, estimates there to be a risk for a 70 percent increase in unhealthy summertime ozone levels by 2050. “It doesn’t matter where you are in the United States—climate change has the potential to make your air worse,” said NCAR scientist Gabriele Pfister, the lead author of the new study, in a release. “A warming planet doesn’t just mean rising temperatures, it also means risking more summertime pollution and the health impacts that come with it.” The American Public Health Association (APHA) expressed strong support for the report’s findings. “As public health workers we can act to protect people from climate change’s long reach by working in concert across sectors,” said Georges Benjamin, MD, executive director of APHA. “Life-saving prevention is within reach, but must include collaboration between health practitioners and our energy, agriculture and transportation leaders.” Read more on air quality.
New Rule Requires Employers to Notify Laid-off Workers of Option to Enroll for Coverage Under ACA
In addition to paying for the full cost of laid-off employees’ work-based health coverage under COBRA, employers must now also notify laid-off workers of their option to purchase health care coverage through the Affordable Care Act’s online marketplaces, according to The Wall Street Journal. The rule was issued late last week by the Obama administration. COBRA—short for the Consolidated Omnibus Budget Reconciliation Act of 1985—allows laid-off workers to maintain their work-based coverage as long as they keep paying their share of the premium. The cost can be “a shock to people,” according to the newspaper, and ACA coverage can provide an alternative. Read more on the Affordable Care Act.
CDC: Many Annual Deaths Are Preventable
Each year, nearly 900,000 Americans die prematurely from the five leading causes of death—yet 20 to 40 percent of the deaths from each cause could be prevented, according to a new study from the U.S. Centers for Disease Control and Prevention (CDC). The five leading causes of death in the United States are heart disease, cancer, chronic lower respiratory diseases, stroke and unintentional injuries. Together they accounted for 63 percent of all U.S. deaths in 2010, with rates for each varying greatly from state to state. The study suggests that if all states had the lowest death rate observed for each cause, it would be possible to prevent:
- 34 percent of premature deaths from heart diseases, prolonging about 92,000 lives
- 21 percent of premature cancer deaths, prolonging about 84,500 lives
- 39 percent of premature deaths from chronic lower respiratory diseases, prolonging about 29,000 lives
- 33 percent of premature stroke deaths, prolonging about 17,000 lives
- 39 percent of premature deaths from unintentional injuries, prolonging about 37,000 lives
Modifiable risk factors such smoking and obesity are largely responsible for each of the leading causes of death, according to the CDC. Many of these risks are avoidable by making changes in personal behaviors, while others are due to social, demographic, environmental, economic and geographic disparities in the neighborhoods in which people live and work. Southeastern states had the highest number of preventable deaths for each of the five causes. The study authors suggest that states with higher rates can look to states with similar populations, but better outcomes, to see what they are doing differently to address leading causes of death. Read more on community health.
Cost of Fighting Wildfires Projected to Skyrocket this Year
The U.S. Department of the Interior (DOI) is projecting that fighting wildfires in 2014 will cost $470 more than is currently available."With climate change contributing to longer and more intense wildfire seasons, the dangers and costs of fighting those fires increase substantially," said DOI Assistant Secretary of Policy, Management and Budget Rhea Suh. Drought conditions in the West, especially in California, combine with other factors to predict a dangerous fire season. Last year, 34 wildfire firefighters died and wildfires burned 4.1 million acres and 1,000 homes. The department would have to divert funds from other programs, which it has previously done. Department officials say climate change is a factor in the increase in wildfires. Read more on the environment.
Starting Antidepressant Treatment at Highest Doses Increases Suicide Risks for Kids and Teens
Children and young adults who start antidepressant therapy at high doses, rather than at the typically prescribed doses, appear to be at greater risk for suicidal behavior during the first 90 days of treatment, according to a study in JAMA Internal Medicine. The rate of suicidal behavior among children and young adults who started antidepressant therapy at high doses was about twice as high compared with a control group of patients who received a typically prescribed dose. Read more on mental health.
Place Matters is a national initiative of the Joint Center for Political and Economic Studies designed to build the capacity of local leaders around the country to identify and improve the social, economic and environmental conditions that shape health. “Addressing upstream causes of poor health, such as issues related to employment, education, poverty, and housing and environmental health risks through community action, policy development, and measuring the indicators associated with these determinants of health, are at the heart of our Place Matters work,” said the project’s program director, Autumn Saxton-Ross, PhD.
Nineteen Place Matters teams are currently working in 27 jurisdictions. This week NewPublicHealth will be highlighting six teams, chosen by Ross as representing both what needs to be fixed and what can be done.
Jefferson County, Alabama is the most populous county in the state. The Place Matters team, headquartered at the University of Alabama at Birmingham, found that the county leads the nation in chronic diseases and conditions linked to premature death, disability, decreased productivity and high health care costs. The leading causes of death in the county are heart disease, cancer and diabetes, and the county also exceeds state and national rates for obesity.
“At the heart of the Jefferson County Place Matters Team is a commitment to empowerment and civic engagement,” said team leader Monica Baskin, PhD, as associate professor of preventive medicine at the University of Alabama/Birmingham Nutrition and Obesity Research Center. The team works to improve the social determinants of health by:
- Informing and illuminating public policy debates via research, analysis and information dissemination
- Building capacity of community leaders
- Facilitating community action planning and implementation.
Baskin, who has led the team for two and half years, said it has so far focused on improving access to healthy, affordable foods; physical activity opportunities; and obesity-related issues. The team also released a health equity report about the county, timed to coincide with the 50th anniversary of the Birmingham campaign, a touchstone moment in the U.S. civil rights movement.
Mistrust, Perceived Discrimination Affect Young Adult Latinos’ Satisfaction with Health Care
Mistrust of the medical community and perceived discrimination can affect how satisfied young adult Latinos are with their health care, which in turn can influence health outcomes, affect participation in health care programs under the Affordable Care Act and contribute to disparities in health care access, according to a new study in The Journal of Rural Health. Researchers surveyed 387 young adult Latinos, ages 18-25, finding that approximately 73 percent were moderately or very satisfied with their health care, but among those who were not, medical mistrust and perceived discrimination were found to be factors. The researchers recommend improving “cultural competency” among health care providers—from the doctors to the receptionists to the lab technicians—to help ensure Latinos are treated with respect and dignity, and also that a bilingual/bicultural workforce may be more effective at building trust. “Trust is huge; it allows patients to disclose concerns and be honest,” said study co-author S. Marie Harvey, associate dean and professor of public health at Oregon State University in a release. Read more on health disparities.
FDA Approves First Sublingual Home Treatment for Hay Fever
The U.S. Food and Drug Administration (FDA) has approved the first sublingual—or under the tongue—allergen extract for use in the United States. Designed to treat hay fever with or without conjunctivitis that results from exposure to certain grass pollens in people ages 10-65, the first dose is administered in a health care providers office so that the patient can be observed for any adverse reactions, but can then be taken at home. Approximately 30 million Americans and 500 million people worldwide are affected by hay fever, also known as allergic rhinitis, which can cause repetitive sneezing; nasal itching; runny nose; nasal congestion; and itchy and watery eyes. “While there is no cure for grass pollen allergies, they can be managed through treatment and avoiding exposure to the pollen,” said Karen Midthun, MD, director of the FDA’s Center for Biologics Evaluation and Research, in a release. “The approval of Oralair provides an alternative to allergy shots that must be given in a health care provider’s office.” Read more on the FDA.
New Report Analyzes Link Between Metro Areas and Overall Health
People who live in compact, connected metropolitan regions are more likely to see their incomes rise, have lower household costs, have more transportation options and live longer, safer and healthier lives, according to Measuring Sprawl 2014, a new report from Smart Growth America and the University of Utah’s Metropolitan Research Center. The report looks at 221 major U.S. metropolitan areas, ranking them based on how sprawling or compact they are as well as examining how sprawl relates to factors such as economic mobility; the cost of housing and transportation; life expectancy; obesity; chronic disease and safety. “Smart growth strategies are about making life better for everyone in a community,” said Geoff Anderson, President and CEO of Smart Growth America. “If policymakers are looking for ways to lower costs for their constituents, improve public health and support their broader economy, they need to be thinking about how to improve their development.” Read more on community health.
EPA Sets Cleaner Fuel and Car Standards to Cut Air Pollution and Improve Health
The U.S. Environmental Protection Agency (EPA) today finalized emission standards for cars and gasoline to significantly reduce harmful pollution and prevent thousands of premature deaths and illnesses. According to the EPA, the new standards will also create efficiency improvements for cars and trucks. The standards go into effect by 2017.
The new standards cut emissions of a range of harmful pollutants that can cause premature death and respiratory illnesses. By 2030, EPA estimates that up to 2,000 premature deaths; 50,000 cases of respiratory ailments in children; 2,200 hospital admissions and asthma-related emergency room visits; and 1.4 million lost school days, work days and days when activities would be restricted due to air pollution will be prevented. Total health-related benefits in 2030 will be between $6.7 and $19 billion annually.
The program will also reduce exposure to pollution near roads. More than 50 million people live, work, or go to school in close proximity to high-traffic roadways, and the average American spends more than one hour traveling along roads each day. Read more on environment.
Study Finds Many Parents Support Flu Shots at School
Half of parents in the United States would agree to have their children get their flu shots at school, according to a survey from the Brown School of Public Policy at Washington University in St. Louis. Researchers at the school conducted a nationally representative online survey of more than 1,000 parents of school-aged children. Convenience was the chief reason for parents supporting flu shots at school. Thirty two percent of parents surveyed were not sure if they would consent to giving the shots at school and 17 percent said they would not consent. Most likely to support flu shots at school were college-educated parents and parents of uninsured children. The study was published in the journal Vaccine.
Flu season can last in the United States through April, according to the U.S. Centers for Disease Control and Prevention (CDC). This is especially the case in communities where the season started later in the fall or early winter. In a recent report, CDC researchers found that the flu vaccine “offered substantial protection against the flu this [2013-2014] season,” reducing a vaccinated person’s risk of having to go to the doctor for flu illness by about 60 percent across all ages
“We are committed to the development of better flu vaccines, but existing flu vaccines are the best preventive tool available now. This season vaccinated people were substantially better off than people who did not get vaccinated. The season is still ongoing. If you haven’t yet, you should still get vaccinated," said CDC director Tom Frieden, MD, MPH, in a recent release. Read more on flu.
Online Ratings Currently Not Used Much to Choose Physicians
Online ratings that review physicians can influence which doctor a patient chooses, but most patients rank insurance acceptance and distance from home or office as more important, according to a new study in JAMA.
- 9 percent of responders said they consider doctor rating websites “very important” in their search for a physician
- 89 percent of responders ranked “accepts my health insurance” as “very important.”
- 59 percent said a convenient office location very important
The study also found that only five percent of those surveyed have ever posted ratings online, although two-thirds of responders were aware of ranking sites, a higher percentage than found in previous studies.
“These may seem useful, but no one is regulating this ‘crowdsourced’ information about doctors. There’s no way to verify its reliability, so online ratings may not currently be the best resource for patients,” David Hanauer, a primary care pediatrician and clinical associate professor of pediatrics at C.S. Mott Children’s Hospital in Detroit. Read more on community health.